In January, Centene named Alan Silver as president of its Ambetter Health Solutions business, colloquially becoming the company’s first ICHRA president.
Individual Coverage Health Reimbursement Arrangements allow employees to shop on the ACA marketplace for a health plan using a tax-free stipend from their employer.
Centene has more than 5.6 million members in the individual market. In December, company executives said they are focused on acquiring health plans and companies that could boost the ICHRA business. Centene also expanded its ACA and ICHRA geographic reach for 2025.
Mr. Silver joined the Becker’s Payer Issues podcast to discuss the company’s strategy in the growing market — that episode will air later this month.
Question: You’re the first “president of ICHRA” at Centene. Why did the company want to create this position?
Alan Silver: Some of it is based on the tradition of what Ambetter Health is — the largest individual market carrier that has been creating tailored healthcare plans for millions over the past decade. There’s an understanding that we have a responsibility. If there is an individual market solution such as ICHRA, we need to be championing and leading that effort to keep pace with an evolving landscape. I’m someone with experience in traditional group health plans to help understand how we might innovate in the individual market realm to meet the needs of employers. It’s really important for Centene to have someone at the head of this strategy, which represents a great opportunity for both the company and the market at large.
Q: What does the ICHRA landscape look like today? How many enrollees, and what kind of employers are interested?
AS: The current environment is one of constant evolution. From the HRA Council data and other data points we have, we can see somewhere between 500,000 and 1 million people are eligible for ICHRA, and some 250,000 to 750,000 people are enrolled at this point in time. The nature of these estimates makes it a very wide range, but it’s starting to become a significant portion of the employer-sponsored landscape. The leaders in this space have been small group employers. The reason for that is the direct comparison between small group rates on insurance and individual market rates. Many small group employers have taken the opportunity to seize the more efficient way of providing benefits. Interestingly, 83% of them hadn’t provided insurance before, so this gives them an opportunity to provide a benefit they haven’t in the past. The greatest growth, however, is seen in employers with 200 or more lives. Large and midsize employers are really coming into this space because they understand the promise of what ICHRA can do for them, especially given the population they’re covering.
Q: How do you see ICHRA evolving in the next five years?
AS: The next 18 to 24 months are crucial for the growth of ICHRA. It’s growing year over year, but the reality is, we need to take a look at what employer group-sponsored coverage is doing these days. The issue we face is a multi-generational workforce — four generations working within the workforce today. This includes the young professional who’s relatively healthy, the family of four with two kids under three, someone managing a chronic condition, and people on benefits to bridge the gap between retirement and Medicare. These are just a few examples of people who need very different things from their healthcare. The growth in ICHRA will come from this concept of a direct-to-consumer approach to healthcare. We anticipate this model becoming more streamlined in the next few years, but we absolutely need some technology enhancements, education and decision support tools to make this vision of a multi-generational workforce a reality in the ICHRA space.
Q: What are the biggest challenges you see facing ICHRA? What about top challenges when promoting this model to employers?
AS: If I had to drive one point home, it’s education — for employers, brokers (both on a group and individual basis), health systems and payers. We all need to get to a place where we understand what the future of this could look like. It’s a new category, growing quickly, and it will face challenges. Beyond education, one of the other challenges is technology. We really need to embrace the world of consumers making their own choice in health insurance. We need to reach a place where decision support is in place, with systems connecting carriers, brokers, employers, and ICHRA administrators to make this a positive experience. At Ambetter, we bear responsibility to meet the needs of individuals by building networks, creating designs and fostering good relationships with local health systems and providers to ensure that people actually want to purchase the health insurance coverage we offer.
Q: Should other insurers be considering entering this market?
AS: Other insurers will need to have a very intentional strategy around entering the ICHRA space. It’s an obvious play for us at Ambetter because we don’t have a group business. For us, we’re pushing an individual solution, and that’s why we see ourselves as a leader in this space. For other carriers, that may not be the case. They’ll need to make a decision: either get in with us in building a direct-to-consumer world, or maybe it’s just not for them. It’s crucial to understand that you can’t just do this on the side. You actually need to commit to meeting the needs of the employee population.
